Prediction of serum indexes of major adverse cardiovascular events in acute myocardial infarction

Objective To analyze the predictive value of serum soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular intercellular adhesion molecule-1 (sVCAM-1) and soluble microfiber associated protein 4 (sMFAP4) for major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in acute myocardial infarction.

Methods A total of 166 patients with acute myocardial infarction after PCI were included in case group, and 166 healthy volunteers were included in control group during the same period. Enzyme-linked immunosorbent assay was used to detect serum levels of sICAM-1, sVCAM-1 and sMFAP4, and the differences between groups were compared. After being followed-up for 1 year, the case group was divided into MACE group (n=42) and non-MACE (n=113) group after removing 10 cases. General information was compared between the MACE group and the non-MACE group. Logistic regression analysis was used to identify the influencing factors for MACE; receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was used to evaluate the efficacy of relevant indicators in predicting MACE.

Results The incidence of MACE was 27.10%. The serum levels of sICAM-1, sVCAM-1 and sMFAP4 in the case group were significantly higher than those in the control group, and those in the MACE group were significantly higher than those in the non-MACE group (P < 0.05). Smoking history (OR=3.688, 95%CI, 1.107 to 12.286), drinking history (OR=3.364, 95%CI, 1.238 to 9.139), combined hypertension (OR=4.255, 95%CI, 1.250 to 14.483), combined type 2 diabetes (OR=4.208, 95%CI, 1.051 to 16.856), combined hyperlipidemia (OR=5.238, 95%CI, 1.440 to 19.061), Gensini score (OR=5.579, 95%CI, 1.355 to 22.968), blood platelet count (PLT) (OR=0.519, 95%CI, 0.281 to 0.961), serum sICAM-1 (OR=5.013, 95%CI, 1.859 to 13.514), sVCAM-1 (OR=4.826, 95%CI, 1.769 to 13.164) as well as sMFAP4 (OR=4.745, 95%CI, 1.372 to 16.407) and no reflow during surgery (OR=2.962, 95%CI, 1.107 to 7.924), no collateral circulation formation (OR=3.225, 95%CI, 1.173 to 8.867) were all influencing factors for the occurrence of MACE. Serum sICAM-1, sVCAM-1 and sMFAP4 levels predicted the cut-off value of MACE in the case group were 331.53 ng/mL, 473.20 ng/mL and 30.63 U/L, respectively, the sensitivity was 80.95%, 76.19% and 78.57%, respectively, the specificity was 94.69%, 97.35%, 88.50%, respectively, and the AUC was 0.835 (95%CI, 0.767 to 0.890), 0.794 (95%CI, 0.722 to 0.855), 0.824(95%CI, 0.754 to 0.880), respectively. The sensitivity, specificity and AUC of serum sICAM-1, sVCAM-1 and sMFAP4 to predict MACE were larger or higher than those of Gensini score (P < 0.05); the sensitivity, specificity and AUC of the above serum indexes combined to predict the occurrence of MACE in the case group were 100.00%, 94.69% and 0.956 (95%CI, 0.910 to 0.982), respectively, and the sensitivity and AUC of the combined prediction were higher or larger than those of the single prediction (P < 0.05).

Conclusion Serum sICAM-1, sVCAM-1 and sMFAP4 levels are increased in patients with acute myocardial infarction, all of which are related to MACE after PCI. The MACE prediction value of the three is better than Gensini score, and the combined prediction value of the three is higher.